NO MATTER how much his parents yelled at him to bathe and have his meals, the teenager would not budge.

The 17-year-old would remain glued to his computer screen, engrossed in his computer game, World of Warcraft.

Throughout a six-month period, he often skipped meals and baths, until his parents decided that their son needed help.

They took George (not his real name) to Ms Vanessa von Auer, clinic director and psychologist at the VA Psychology Centre.

'When he came to me, he did not think that he had a problem,' said Ms von Auer.

'But his hygiene problems actually showed that he was losing the ability to distinguish between reality and his virtual world.'

Is this blurring of lines between the virtual and real world that led to the death of two boys last year?

A coroner's inquest into their deaths this week heard that eight boys had made a suicide pact, in the belief they would be resurrected as slayers to save the world.

Two of them eventually leapt to their deaths from a HDB block, while the rest backed out.

Some members from the group were reportedly avid players of multi-player online games Romance of the Three Kingdoms and World of Warcraft, although there was no evidence that the games had influenced the suicide pact.

Mr Daniel Koh, a psychologist with Insights Mind Centre, has seen a spike in teenagers coming to him for gaming addictions.

He has already seen more than 15 cases this year, compared to 10 in the whole of last year, and fewer than 10 cases in 2005.

'Many of these teenagers are very defensive and refuse to seek help,' said Mr Koh.

This is a common reaction, he added.

He said teens usually start off seeing the game as a 'fun thing'.

They soon become hooked because the games allow them to 'save the world' and 'feel powerful and heroic', said Ms von Auer.

'These achievements in the virtual world are not real, but it makes the teens feel like they have contributed and made a difference in that world, which is more difficult to do in real life.'

It becomes a problem when 'the distance between reality and virtual reality starts to blur', said Dr Ang Peng Chye, a consultant psychiatrist in private practice.

'The game takes on a reality of its own, and the teenager is increasingly sucked into this 'alternate universe',' he said.

They start to give themselves self-empowering names, such as 'King', 'Wildfire', or, in George's case, 'Mountain Emperor'.

Group identities are formed too, as many of the online games involve multiple players.

'This is popular because the group is seen as exclusive. And it especially appeals to teenage boys' desire for belonging,' said Dr Ang.

'They make appointments to meet online after work, sign in online together, and do not start until all other group members are present.'

Dr Ang said that when the gamers' 'alternate universe' starts to consume their entire waking life, there is a serious problem.

The games are often a form of escape.

Ms von Auer said: 'They seek to avoid their real-life struggles - low self-esteem, bullying, loneliness, depression, parental pressure, and emotional immaturity - by escaping into their fantasy world.

'Teenagers can take on roles and become anything they want to be in the virtual world.'

Mr Koh added that the open-ended nature of the games makes it easy to become addicted to them.

'The multiple possibilities of the game keep the teens stimulated, thrilled, and attracted to playing it,' he said.

But Dr Ang said not all teens are susceptible to addictions.

'There are many people playing these games who turn out fine. But if the person playing it is not stable, then the game pushes his or her problem to the fore,' he said.

He feels that teenagers with 'inherent problems' such as low self-esteem are more likely to end up addicted to the game.

Dr Ang said it is important for parents to look out for tell-tale signs.

Red flags include 'lazy' or 'anti-social' behaviour, said Ms von Auer.

Added Mr Koh: 'Your teen's isolation from the world should be a warning sign for you to bring them to seek professional help.

'It might be difficult to get them out of the house, but you have to, before they lose their grip on reality altogether.'

George was one of the lucky ones.

Ms von Auer had weekly sessions with him, and treated him for eight months before he recovered. She taught him conversational skills.

George's parents were also roped in to help limit the time their son spent on the computer.

'He finally saw gaming as a hobby, and not an obsession,' she said.

Gaming and violence: A link?

WITHIN and beyond our shores, there have been cases of gamers pulling the trigger in real life.

Is there a link between violent video games and physical aggression? The jury is still out.

Earlier this year, The New Paper reported that Indonesian David Hartanto Widjaja, 21, was hooked on online multi-player game Destiny Online up to the eve of his death.

The game involved the killing of monsters to gain points. Mr Widjaja's online character name was Majin (Japanese for demon god or magical being).

Tim Kretschmer, 17, who was responsible for the Winnenden secondary school massacre in south-western Germany last March also played violent video games and had virtual world avatars (online character names).

The games he engaged in were first-person shooter games such as Counter-Strike and Far Cry 2, and his avatar for the latter was 'JawsPredator1'.

He killed 16 people before turning the gun on himself.

Another avid gamer, Cho Seung-Hui, 23, a senior English major at Virginia Tech in Blacksburg, Virginia, killed 32 people in two separate attacks about two hours apart on 16 Apr, 2007.

Like Kretschmer, he, too, shot himself. And like Kretschmer, he was an avid player of Counter-Strike.

At that time, Florida attorney Jack Thompson insisted that the game was to blame for Cho's actions.